Wu Yuanhong , a man suffering from schizophrenia in China 's southeastern Jiangxi Province , was forced by his mother to live in a small metal cage for 11 years after he beat a young boy to death .

Reports of Wu 's dire situation surfaced in Chinese media last May , accompanied by images of the 42-year old sitting in the cage in his underwear , his feet shackled by a heavy chain .

Cases similar to Wu are not unheard of in China . Work pressure , the breakdown of traditional family structures , and other aspects of China 's rapid modernization have brought an increase in psychological stress to the population .

There are often reports of violent , random attacks , killings and suicides . One of the most memorable was when a depressed 27-year-old factory worker tried to feed himself to a pair of Bengal tigers at a Chengdu zoo by jumping into their cage last February .

Not enough help

The country 's public health system is struggling to keep up with the demand in mental health care .

Around 173 million Chinese suffer from a mental disorder , according to a 2009 study published in British medical journal The Lancet . But there are only 20,000 psychiatrists , equaling 1.5 for each 100,000 people , or a tenth of the ratio in the United States .

Professor Michael Phillips , director of the Shanghai Mental Health Center at Shanghai Jiao Tong University , estimated that only 5 % of people who currently have a mental illness in China have received psychiatric care from a professional .

`` The factors that affect the low care-seeking rates are many , '' he said . `` Lack of awareness that they suffer from a psychiatric condition , lack of locally available mental health services , fear of stigma , belief that seeking psychological help will be useless , costs , etcetera . ''

Dubious therapy

As a response to the massive demand for help with mental health problems , under-qualified mental health practitioners have sprung up across the country .

Dr. Sammy Cheng Kin-wing , Hong Kong-based chairman of the Division of Clinical Psychology , part of the Hong Kong Psychological Society , said he receives many complaints from the public .

Commonly complaints are about unregistered psychologists who give unprofessional advice to clients , fail to provide proper assessments and break confidentiality .

`` Many people are setting up practices in mainland China . Some are well-trained , but that 's just a minority . Because the need is so great , the unqualified can still run their businesses and offer treatment . I 've been in contact with patients who feel very angry over services received , sometimes with emotional state worsened during treatment . They said they would never see a psychologist again , '' said Cheng .

Professor Phillips agreed that `` charlatans occur everywhere '' and `` there are uneducated subgroups in China that are gullible . ''

`` In terms of professional services there are certainly locations with sub-standard levels of care , primarily because of a lack of trained personnel , '' he added .

` Ankang '

Ironically , while those in genuine need of help have been unable to get any , the government has used confinement in mental institutions as a way to silence political dissenters , human rights activists claim .

Nicholas Bequelin , a senior researcher at Human Rights Watch -LRB- HRW -RRB- in Hong Kong , said it 's a method that has been used increasingly over the past decade , calling it `` an absolute violation of medical ethics . ''

One of those alleged to have been a victim of the practice , is Xing Shiku . Chinese Human Rights Defenders say he has been incarcerated in a psychiatric hospital in Heilongjiang Province for more than six years . Xing , they say , had been filing complaints to the central government about corruption and other problems related to the privatization of the state-owned company where he worked .

These mental institutions are called `` ankang '' -LRB- `` peace and health '' -RRB- hospitals and are managed by the Public Security Bureau . Treatments include beatings and electric shocks , according to HRW . As of 2011 , there were some 20 `` ankang '' institutions operating in China .

Although China 's National Health and Family Planning Commission did not directly respond to the allegations , they stated that `` China 's mental health organizations strictly follow laws when practicing diagnosis and treatment . '' They added that diagnoses of mental disorders are made according to the Chinese Classification of Mental Disorders and International Classification of Diseases .

Baby steps

The government has taken steps to address the shallow mental health system , such as financing mental health services and provide training for primary care providers . Most notably , a new mental health law was introduced last year -- it took 27 years to pass the legislation .

Among the most significant changes was a new set of rights for patients , including not being hospitalized against their will .

Despite constructive changes , HRW argues that there are still plenty of loopholes .

`` The very first test of the mental health law will be whether those held in psychiatric facilities for political reasons are immediately released , '' the organization 's China director , Sophie Richardson , said in a statement .

The new law is a big step in the right direction , most commentators say . But a voluntary admissions system will further increase the need for more mental health practitioners and community-based services , potentially sending a system already in disarray into further decline .

While a wholesale reform of the mental health system is needed , one expert says no number of laws and certifications can help therapists gain the most important skill of all : a nuanced understanding of human emotion .

Harry Hoffmann and his wife Tina , a psychological counselor , run Da Wen , a counseling and coaching private practice in Kunming , Yunnan Province . Part of their business is to train those who wish to become therapists themselves .

`` I met a man from Chengdu with a master degree in psychology who said ' I have learned nothing about inner feelings and emotions -LRB- from school -RRB- . Can you help me to gain those skills ? ' '' said Hoffmann . `` For me , therapy is almost like art , with a set of ethical guidelines and a holistic health approach . ''

Factory life far from home leaves China 's migrant workers vulnerable

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There are 1.5 therapists for each 100,000 mental illness sufferers

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Unqualified therapists prey on the weak , worsening their condition

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Human Rights Watch says mental hospitals are filled with political prisoners